Treatment
A specialist on the field should treat acute lymphoblastic leukemia. These patients have very especial needs and may require supportive care through transfusion of blood products, hydration, and isolation to prevent infections. After ALL is diagnosed, patients should stay hospitalized to start the first doses of chemotherapy as soon as possible. This is called induction chemotherapy, and include both chemotherapeutic drugs and steroid drugs depending on each individual patient.
Then, consolidation therapy is started to give patients an increased chance of survival after 3 years. When patients improve their condition. Another option would be a transplant, which is why not many patients need maintenance therapy.
In treating ALL, we should not only care about the number of aberrant lymphocytes but also other diseases that may be triggered by leukemia. Since meningeal leukemia is very prevalent in patients with a relapse, doctors may choose to administer intrathecal chemotherapy to prevent the involvement of the central nervous system. We should also reduce the risk of infection through antibiotic and antifungal prophylaxis, and keep an eye on the blood values of patients to guide supportive therapy.
Even when patients are stable, it is essential to maintain long-term monitoring as an outpatient. Some of them have a higher risk of relapse and should be treated with itraconazole and antifungal therapy while others have a higher risk of Pneumocystis jiroveci pneumonia, and should be treated with trimethoprim-sulfamethoxazole.
References
Brisson, G. D., Alves, L. R., & Pombo-de-Oliveira, M. S. (2015). Genetic susceptibility in childhood acute leukaemias: a systematic review. Ecancermedicalscience, 9.
O’Donnell, M. R., Tallman, M. S., Abboud, C. N., Altman, J. K., Appelbaum, F. R., Arber, D. A., … & De Lima, M. (2017). Acute myeloid leukemia, version 3.2017, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network, 15(7), 926-957.
O’Donnell, M. R., Abboud, C. N., Altman, J., Appelbaum, F. R., Arber, D. A., Attar, E., … & Lancet, J. (2012). Acute myeloid leukemia. Journal of the National Comprehensive Cancer Network, 10(8), 984-1021.
Kantarjian, H. (2016). Acute myeloid leukemia—major progress over four decades and glimpses into the future. American journal of hematology, 91(1), 131-145.